Department of Orthopaedic, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Orthopaedic, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Orthop Surg. 2023 Jan;15(1):124-132. doi: 10.1111/os.13574. Epub 2022 Nov 16.
Failed internal fixation of intertrochanteric fractures (FIF-ITF) is often treated by conversion hip arthroplasty (CHA). This study aimed to evaluate the results and complications of using standard and long femoral stems in this operation.
This retrospective, multi-center study enrolled 31 total hip arthroplasty (THA) and 23 hemiarthroplasties (HA) cases (30 women, 24 men; mean age 76 years) after FIF-ITF between 2012 and 2019, divided into two groups: standard stem group (n = 20) and long stem group (n = 34). The initial internal fixation includes 38 cases of proximal femoral nail anti-rotation (PFNA), eight cases of the dynamic hip screw (DHS), and eight cases of locking proximal femoral plate (LPFP). The indications for CHA included 38 cases of failure of fixation, seven cases of nonunion, and nine cases of avascular necrosis or posttraumatic osteoarthritis. Perioperative data and complications related to fracture and operation were collected, and preoperative and postoperative clinical and radiological data were analyzed. Clinical outcomes were assessed using Harris hip score (HHS) and 36-item Short Form survey (SF-36: including physical function (PF) score and body pain (BP) score). Statistical analyses were performed using the chi-square or Fisher's exact test, and the 2-sample t-test or Wilcoxon rank sum test.
At an average of 5.6 years with a minimum of 2 years follow-up. A significant overall surgeon-related complication rate was detected (27.8% [15/54]), five cases had an intraoperative femur fracture, one case had a late periprosthetic femoral fracture, two cases had a stem penetration, one case had a cement leakage, and two patients had an early postoperative dislocation, one infection and three cases of stem loosening or subsidence. Long stems had an increased risk of complication (13/34) compared to standard stems (2/20) (P = 0.031). The operation time and blood loss in the long stem group were higher than those in the standard stem group (P = 0.002; 0.017). HHS and SF-36 significantly improved in both groups from preoperative to the final follow-up and did not present significant differences at the final follow-up (P > 0.05).
CHA following FIF-ITF showed a successful mid-term clinical result, long stem arthroplasty should be approached with caution for the risks of higher complication rate, especially intraoperative femoral fractures.
股骨转子间骨折内固定失败（FIF-ITF）常需行髋关节置换术（CHA）。本研究旨在评估标准和长柄股骨假体用于此类手术的效果和并发症。
本回顾性、多中心研究纳入 2012 年至 2019 年间因股骨转子间骨折内固定失败而行初次全髋关节置换术（THA）31 例和半髋关节置换术（HA）23 例（女性 30 例，男性 24 例；平均年龄 76 岁），分为标准柄组（n=20）和长柄组（n=34）。初始内固定包括 38 例股骨近端防旋髓内钉（PFNA）、8 例动力髋螺钉（DHS）和 8 例锁定近端股骨钢板（LPFP）。CHA 的适应证包括 38 例固定失败、7 例不愈合、9 例股骨头缺血性坏死或创伤后骨关节炎。收集与骨折和手术相关的围手术期数据和并发症，分析术前和术后的临床和影像学资料。采用 Harris 髋关节评分（HHS）和 36 项简短健康调查（SF-36：包括躯体功能（PF）评分和躯体疼痛（BP）评分）评估临床疗效。采用卡方或 Fisher 确切概率法检验、两样本 t 检验或 Wilcoxon 秩和检验进行统计学分析。
平均随访 5.6 年（最短 2 年）。总体发现了较高的与术者相关的并发症发生率（27.8%[15/54]），包括 5 例术中股骨骨折、1 例晚期假体周围股骨骨折、2 例柄穿透、1 例骨水泥渗漏、2 例术后早期脱位、1 例感染和 3 例柄松动或下沉。与标准柄组（2/20）相比，长柄组（13/34）的并发症风险更高（P=0.031）。长柄组的手术时间和出血量均高于标准柄组（P=0.002；0.017）。两组患者的 HHS 和 SF-36 评分在术前至末次随访时均显著改善，且末次随访时无显著差异（P>0.05）。
股骨转子间骨折内固定失败行髋关节置换术中期临床效果满意，但长柄假体置换术的并发症发生率较高，特别是术中股骨骨折的风险较高，应谨慎使用。
